Disclaimer for Job Postings Note: The compensation range noted above represents the base salaries for all positions at a given grade acrossthe health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries will be determined based on the candidates relevant experience. No employee will be paid below the minimum of the range. Holyoke Medical Center is looking for a Sr Insurance Specialist. This position manages complex medical claims, acting as a subject matter expert to investigate, adjudicate negotiatesettlements, ensure compliance and mentor junior staff, focusing on accurate and timely and cost-effective claims resolution whilemaintaining strong communication with providers, payers and internalteams. Works all claims as assigned/directed. DUTIES AND RESPONSIBILITIES: ï‚· Serve as subject matter expert, providing guidance on policy, regulations and complexclaims scenarios. ï‚· Conduct in-depth analysis, research discrepancies, prevent fraud and develop plans forclaims resolution. ï‚· Handles escalated inquires, build relationships with providers/payers and communicateclaims status. ï‚· Assist in training, coaching and provide senior support to less experienced teammembers. ï‚· Review and process complex hospital claims and determine coverage based on policy,medical necessity and contracts. ï‚· Able to work all aspects of Commercial Managed Care, Medicare Advantage, andMedicaid Advantage Care accounts sliding between Financial Classes as needed forBilling, Follow-up, Denials Management, Credit Balance and Account resolution. Required Skills ï‚· Must show honesty, integrity, strong ethics, data entry skills and time management skills ï‚· Insurance follow up experience especially Blue Cross and all Commercial Lines ï‚· Strong understanding of Medetech and finThrive billing programs ï‚· Strong Verbal and written skills for preparing and presenting appeals, negotiating settlementsand presenting reports to Senior Management. ï‚· Proactive approach to resolving discrepancies between insurance policy terms and providercharges ï‚· Ability to analyze complex data, identify issues and solve problems ï‚· Proven background in handling complex institutional or healthcare related claims ï‚· Proficiency with claims software and MS Office (especially Excel). ï‚· Strong time management, organization skills and ability to work independently or in a team ï‚· Good plus knowledge of ICS/HCPCS/CPT Coding and medical terminology ï‚· Knowledge of commercial, state and federal healthcare regulations ï‚· Excellent Math Skills and knowledge of general accounting principals ï‚· Ability to logically and accurately organize data ï‚· Excellent problem solving skills ï‚· Strong attention to detail QUALIFICATIONS/JOB REQUISITES: Education: High School Diploma or GED is required, an Associate or Bachelors degree in HealthAdministration or related Study preferred Experience: Eight plus (8+) years in the health insurance, hospital business office or claimsprocessing/management.